Utilization Patterns and Outcomes From Iron Chelation Therapy in Elderly Patients With Myelodysplastic Syndromes: A...

Iron overload from red blood cell (RBC) transfusions is a source of morbidity and mortality in myelodysplastic syndromes (MDS). Evidence supporting iron chelation therapy (ICT) is limited for elderly patients.

We analyzed real-world ICT utilization and outcomes in the U.S. Surveillance, Epidemiology, and End Results (SEER)-Medicare population. Between 2007 and 2017, MDS patients ≥66 years with ≥2-year survival was identified. Documented iron overload and/or cumulative ≥20 RBC within ≤2 years defined ICT eligibility. Survival, acute myeloid leukemia (AML), and iron-related cardiac and hepatic complications were assessed using multivariable Cox hazards, propensity score matching, and cause-specific regression.

Of 2564 eligible patients with median age 81, 15.3% received ICT. Deferasirox, deferoxamine, and deferiprone were used in 51.7%, 47.8%, and 0.5%, respectively. Predictors of ICT use included ringed sideroblasts histology (OR = 1.9), RBC transfusion density (OR = 1.1 per unit/month), and therapy with erythropoietin stimulating agents (OR = 1.5), hypomethylating agents (OR = 1.31) or lenalidomide (OR = 2.6). Of 352 ICT-treated transfusion-dependent patients, 78.9% achieved hematologic response (≥50% unit/month reduction). Across models, ICT was associated with 47%-48% reduced risk of mortality, 43%-49% reduced risk of AML, and 23%-32% reduced risk of adverse cardiac outcomes, driven by lower risk of heart failure. No effect on hepatic complications was identified.

These results suggest that ICT is associated with fewer transfusions, improved survival, lower risk of AML, and less adverse cardiac outcomes in unselected elderly patients with MDS.